Reimbursement ratio of Wuhan United medical insurance

The actual reimbursement rate varies from 20% to 60% according to the level of the hospital.

Wuhan medical insurance card reimbursement scope:

1, medical insurance card reimbursement is limited to medical expenses above hospitalization for diseases and some accidents in re-designated hospitals;

The reimbursement formula of (1) is: (total expense-threshold expense-self-expense-overrun expense) *(75+ age * 0,2)%. In general, the actual reimbursement rate ranges from 20% to 60%.

(2) Self-funded drugs are not reimbursed, and Class B drugs are reimbursed by 80%. Bed fees are limited, and some inspection fees and medical treatment fees are not reimbursed according to regulations.

2. The reimbursement amount of the medical insurance card is 4 times of the local social wage (1 year accumulated value):

(1) 200 yuan, community health service center, first-class medical institution;

(2) 400 yuan, a secondary medical institution;

(3) 800 yuan, a tertiary medical institution.

3. For hospitalization medical expenses that meet the above requirements of Qifubiaozhun, the payment ratio of medical insurance fund is:

(1) In the community health service center, the hospitalization payment ratio of the first-class medical institutions is 80%;

(2) The proportion of hospitalization payment in secondary medical institutions is 70%;

(3) The proportion of hospitalization payment in tertiary medical institutions is 60%.

Extended data

The reimbursement ratio of Wuhan Medical Insurance Critical Care Clinic is as follows:

1, urban workers:

Outpatient urban workers pay medical expenses with medical insurance IC card.

Severe chronic diseases:

Reimbursement = (total outpatient medical expenses-Class B at its own expense-Class C) ×70% (on-the-job)

Reimbursement = (total outpatient medical expenses-Class B self-care-Class C) ×75% (retirement)

Hospitalization:

Reimbursement portion = (total medical expenses-Class B self-expense-Class C threshold fee) ×83% (on-the-job)

Reimbursement portion = (total medical expenses-Class B self-expense-Class C threshold fee) ×88% (retirement)

Class B: Specialist is conceited, such as MRI 20%, CT20%, B-ultrasound 20%, drugs 5- 10%.

Class c: 100% pays by itself.

Threshold fee: First hospitalization in 600 yuan, second hospitalization in 420 yuan and third hospitalization in 240 yuan.

2, medical insurance for urban residents:

Reimbursement ratio = (total outpatient medical expenses-Class B conceit-Class C) ×35%

Hospitalization reimbursement = (total medical expenses-Class B-Class C -300) × 65%

Birth is included in the medical insurance diseases of residents, and the quota reimbursement is implemented, with 400 deliveries and 700 caesarean sections.